Intended for healthcare professionals

Head To Head Maudsley Debate

Do cases like that of Anders Breivik show that fanaticism is a form of madness? Yes

BMJ 2012; 345 doi: (Published 11 July 2012) Cite this as: BMJ 2012;345:e4612
  1. Max Taylor, professor of international relations1
  1. 1University of St Andrews, St Andrews, Fife KY16 9AX, UK
  1. Correspondence to: mt40{at}

The trial of Anders Breivik, who murdered 77 people in two attacks in Norway, has attracted considerable controversy because of the questions concerning his mental state. Max Taylor argues that such extreme fanatics should be considered insane, but Tom Fahy (doi:10.1136/bmj.e4647) believes that a psychiatric diagnosis is an abrogation of personal and societal responsibility

In psychiatric terms, cases like Anders Breivik’s present diagnostic difficulties. Psychiatry is not like the rest of medicine in that physical investigations such as a blood test or brain scan are rarely diagnostic. Instead, the psychiatrist has to rely on the cooperation of clients. This is especially difficult in court cases of “lone wolf” killers such as Breivik because the psychiatrist’s assessment can have a massive consequence on the outcomes of the trial.

Psychiatric definition

The fanaticism shown by Breivik is of such a degree that no extremist groups endorse his position; and this is exactly what happens in psychosis. Delusional people tend not to be able to gather supporters for their ideas because their reasoning is so off kilter that others cannot follow it. In the same way, Breivik lacks a sufficient basis in reality to explain the consequences of his actions.

Many members of the public are resistant to diagnosing lone wolf killers as insane or having psychological difficulty because of a perception that this allows the killer to escape personal responsibility for their actions. These sentiments were clearly seen in the public outrage which ensued in Norway after the first psychiatric assessment diagnosed Breivik with paranoid schizophrenia. But a psychiatric diagnosis does not absolve someone from personal responsibility for their crime; only in extreme circumstances, when an individual is in the grip of extreme psychosis, might this apply.

While Breivik’s highly organised behaviour may seem to argue against psychosis, there are many psychotic stalkers, for example, who are delusional about a non-existent relationship yet whose harassment is extremely well organised. Both Breivik’s actions and thinking cross the border between sanity and madness.

Terrorism perspective

From Breivik’s manifesto, with its appeal for political change, it is clear that he sees himself as a terrorist. However, his lack of involvement with terrorist organisations seems to indicate that his beliefs were outside the realm of mainstream terrorist groups.

The state of mind of members matters greatly to terrorist organisations undertaking attacks. They recognise the problems of delusional and inconsistent motivations, and exclude people who are irrational from action. As Post notes, with respect to organised terrorist groups, “Terrorists are not crazed fanatics.”1 Taylor and, more recently, Horgan have further argued that there are no psychological traits that distinguish the terrorist from other members of the general population.2 3 Terrorism is in essence a rational activity, although not every radical will become involved in terrorism, and conversely, not all terrorists are necessarily radical.4

Yet some people seem to stand out from this analysis. Breivik is one of them. Breivik does not seem to belong to some greater organisation (other than by his own account5), and his writings are characterised by complex and distorted ideation; yet his actions suggest a well ordered plan of violent activity. This points to one of the challenges we face in understanding terrorist motivation—how do we reconcile the organisational effectiveness that generally characterises political violence with the distorted and irrational ideation that seems to best characterise some of these isolated individuals involved in it? We don’t know the extent to which this might apply more generally, but certainly for lone wolves such as Breivik, it is their isolation that seems important.

Madness and fanaticism are lay terms and have no currency in psychiatry. Does this mean therefore that fanatical killers have to be characterised as “normal”? Taylor identified fanaticism as a focused, highly personalised interpretation of the world that excludes or attenuates other social, political, or personal forces that might be expected to control and influence behaviour.6 This suggests that an acceptable conceptual structure can be identified that might place Breivik, and others like him, within a framework of excessive fanaticism that might be reasonably characterised as a form of madness. Furthermore, such a view has the added virtue of placing the person under secure hospital care and not feeding into his delusional ideational state or that of those who might seek to emulate him.


Cite this as: BMJ 2012;345:e4612


  • “Insane? Cases such as Anders Breivik demonstrate that fanaticism is a form of madness” is the subject of the 45th Maudsley Debate to be held on Thursday 19 July at 6 pm, Harris Lecture Theatre, Hodgkin Building, Guy’s Hospital, London, SE1 1UL (

  • Competing interests: The author has completed the ICMJE unified disclosure form at (available on request from the corresponding author) and declares no support from any organisation for the submitted work; no financial relationships with any organisation that might have an interest in the submitted work in the previous three years; and no other relationships or activities that could appear to have influenced the submitted work.

  • Provenance and peer review: Commissioned; not externally peer reviewed.


View Abstract